骨转移癌病理性骨折72例

发布时间：2018-02-24 14:36

本文关键词： 骨转移癌病理性骨折手术治疗　出处：《中国老年学杂志》2017年04期 　论文类型：期刊论文

【摘要】：目的探讨骨转移癌病理性骨折的临床治疗方法与效果评价。方法骨转移癌病理性骨折并行手术治疗的患者72例。所有的患者术前进行原发灶的筛查,术前常规检查及骨折部位病理穿刺。手术方法分别为瘤段截除人工关节或肿瘤组配式假体置换术、病灶刮除骨水泥填充钢板固定术、髓内针内固定术、单纯瘤段截除术等。采用荷兰模型评分系统评估患者生存期,根据WHO疼痛分级对患者行相应的镇痛治疗。对原发灶采取放疗、化疗、激素治疗、生物免疫治疗、唑来膦酸治疗、中医药治疗等。术后国际骨与软组织肿瘤MSTS评分系统评价术后功能状态,疼痛视觉模拟评分法VAS进行术前术后疼痛评分,对术后肢体功能采用Enneking评分系统评估。结果所有患者均获得随访,随访时间为6~53个月,中位随访时间7个月。术前采用荷兰模型评分系统预测生存期(4.3±2.6)与实际生存期(11.2±11.4)差异显著(P0.05)。VAS评分术前疼痛评分为(7.7±1.3)分,术后明显降低为(2.0±1.4)分(P0.05)。MSTS评分为(21.7±5.9)分。术后3个月Enneking功能评分为33~56分,优良率77.8%。结论恶性肿瘤骨转移是恶性肿瘤终末期的表现,发生病理性骨折严重降低患者终末期生存期及生活质量,积极有效的手术治疗并辅以其他综合治疗能够有效地缓解患者痛苦、利于护理、提高生存质量和延长生存期。
[Abstract]:Objective to investigate the clinical treatment and effect evaluation of pathological fracture of bone metastases. Methods 72 patients with pathological fracture of bone metastases underwent surgical treatment. All the patients were screened for primary lesions before operation. Routine examination before operation and pathological puncture of fracture site. The operative methods were segmental amputation of artificial joint or tumor group prosthesis replacement, focal curettage and bone cement filling plate fixation, intramedullary needle fixation. Simple tumor segment amputation and so on. The survival time was evaluated by the Dutch model scoring system. The patients were treated with analgesia according to the WHO pain grade. The primary tumor was treated with radiotherapy, chemotherapy, hormone therapy, biological immunotherapy, zoledronic acid therapy. MSTS scoring system for postoperative bone and soft tissue tumors, and VAS for preoperative and postoperative pain scores. The limb function was evaluated by Enneking scoring system. Results all the patients were followed up for 6 ~ 53 months. The median follow-up time was 7 months. The mean survival time predicted by the Dutch model scoring system was 4.3 卤2.6) and the actual survival time was 11.2 卤11.4). The preoperative pain score was 7.7 卤1.3). The scores of Enneking function were 33 ~ 56 at 3 months after operation, and the excellent and good rate was 77.8. Conclusion Bone metastasis is the end stage of malignant tumor. The occurrence of pathological fracture seriously reduces the end stage survival and quality of life of patients. Active and effective surgical treatment and other comprehensive treatment can effectively alleviate the pain of patients, nursing care, improve the quality of life and prolong the survival period.
【作者单位】：吉林大学中日联谊医院骨科;
【分类号】：R738.1;R687.3

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